Numerous studies have been published since the early 1980s analyzing the effects of type 1 and type 2 diabetes on fractures, but study findings were inconsistent.

Trials with insufficient statistical power may have contributed to the contradictory results, lead author Dr. Mohsen Janghorbani, currently based at Isfahan University of Medical Sciences in Iran, and associates suggest. They therefore conducted a meta-analysis of published trial results regarding diabetes and low-trauma hip fractures.

The research team reported associations between diabetes and risk of hip fracture as summaries of relative risks (RR). When significant heterogeneity was identified, they conducted a meta-regression analysis to identify trials that contributed the most to heterogeneity, and recalculated associations after excluding those trials.

Adults up to 98 years old participated in the two case-control studies and 14 cohort studies that were identified. Among 836,941 subjects included in the studies, 139,531 fractures occurred.

Twelve studies examined the link between type 2 diabetes and hip fracture incidence, and for these the summary RR was 1.7. After excluding three studies, the association between type 2 diabetes and hip fracture was statistically significant (RR 1.8).

Each of six studies of patients with type 1 diabetes revealed a statistically significant positive association with hip fracture incidence, and the summary RR for all combined was 6.3. After exclusion of one trial contributing to heterogeneity, the association was stronger (RR 8.9).

"Results were consistent between studies of men and women and between studies conducted in the United States and Europe," Dr. Janghorbani and associates report.

They surmise that impaired bone quality may be one culprit responsible for the increased risk of hip fractures among diabetics.

Another possibility, the investigators add, may be "diabetes-related comorbidity, such as diabetic retinopathy, peripheral neuropathy, and cerebral stroke or hypoglycemia, which may increase the risk of falling."
Am J Epidemiol  Sept, 1 2007;166:495-505.

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